Intoeing in Children: Causes and When It Improves

Intoeing (pigeon-toed walking) is a common finding during childhood gait development. Parents usually notice that their child’s feet or legs turn inward while walking. In most cases, it is physiological and improves as the child grows. In some situations, however, closer follow-up or treatment may be required.

Symptoms

• Feet turning inward during walking
• Tripping or imbalance, especially while running
• More noticeable in certain sitting positions (e.g., “W sitting”)
• Occasionally anterior knee pain or fatigue in some children

Examination Findings

The doctor observes the child’s gait and performs a few simple measurements:

• Hip rotation: Measures internal and external rotation of the thigh.
• Thigh-foot angle: Evaluates inward or outward tibial rotation.
• Foot shape: Checks for metatarsus adductus (inward curvature of the forefoot).

Diagnosis and Imaging

Clinical examination is usually sufficient for diagnosis. Imaging is only recommended if the deformity is asymmetric, progressive, painful, or suspicious for an underlying condition. When needed, CT, EOS (low-dose imaging), or MRI can be used.

Treatment

• Observation and parental reassurance: Most cases improve with growth.
• Stretching exercises: Helpful in flexible foot deformities.
• Casting or braces: Used for rigid metatarsus adductus in early infancy.
• Special shoes or orthoses: Do not correct the bone alignment, but may temporarily improve balance.
• Surgery: Rarely required. Considered after 8–10 years of age if pain, cosmetic concerns, or walking difficulties persist. Modern surgical techniques provide safe and effective correction.

Key Notes for Parents

Intoeing is usually a normal part of development and gets better over time. “W sitting” is not harmful. Parents should seek medical advice if there is pain, frequent falling, one-sided worsening, or significant walking problems.

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